AUCTORES
Globalize your Research
Case Report | DOI: https://doi.org/10.31579/2690-1919/081
* Inventor of the Carlson Bridge®, Honolulu, Hawai, USA.
*Corresponding Author: RS Carlson, Inventor of the Carlson Bridge®, Honolulu, Hawai, USA.
Citation: RS Carlson, Dental Arts: Discover Prefabricated Bridging. J Clinical Research and Reports, 4(4); DOI:10.31579/2690-1919/081
Copyright: © 2020 RS Carlson. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 16 March 2020 | Accepted: 28 May 2020 | Published: 12 July 2020
Keywords: prefabricated bridging; dead tooth; dental fixed bridging
The historically recorded art of dental fixed bridging, prosthetic tooth replacement, first begins with a simple gold wire wrapped about one support tooth to another with a dead tooth in between. By the 1800s the process evolves to gold “swedged” shell crowns over teeth, without reduction, and a false tooth attached in between. In the early twentieth century,
about 1907 as a result of Dr. Tagart’s lost wax technique developed, and the electric dental drill, the art of tooth contouring and the cast gold bridge come about.
The historically recorded art of dental fixed bridging, prosthetic tooth replacement, first begins with a simple gold wire wrapped about one support tooth to another with a dead tooth in between. By the 1800s the process evolves to gold “swedged” shell crowns over teeth, without reduction, and a false tooth attached in between. In the early twentieth century,
about 1907 as a result of Dr. Tagart’s lost wax technique developed, and the electric dental drill, the art of tooth contouring and the cast gold bridge come about.
This method of tooth contouring is presented at first as judicious shaving or preparation of the tooth structure and its replacement with cast gold cover, the cast gold restoration. A number of journal articles during this time, however, reported on this process of tooth preparation, often condemning it as “tooth mutilation.” In The Dental Cosmos Vol. 61 1921, Dr. Marcus L Ward, a paragon of pedagogy in his time, admonished his colleagues: “I cannot but sound a warning against any practice that necessitates the misguided mutilation of sound teeth.”
The porcelain-to-precious-metal-crown known as the “Ceramco” was in its infancy by the early 1970’s. Ceramco crowns, PFM, required extensive tooth reduction in the quest of a natural look. Thickness between the metal core and the porcelain was critical in its aesthetic effect.
Today, in the tradition of the Ceramco, the norm is major reduction of all surfaces of the tooth structure preparatory to bridging, about 1.5 to 2mm, or more. In the 60s when “gold was king” gold was used to structure our attachments, crowns, with about 0.5 to 1 mm reduction, and Steel’s Flat Back Facings of porcelain for the pontic facings.
The all-porcelain crown used early in the 1930’s until the 1990’s, the PJC, fell out of use with the advent of PFM crowns. As of this writing, there are many newer materials available to the profession, allowing for the option to avoid metals altogether. However, tooth reduction persists.
Although fixed bridging has evolved as an art and science it still relies on tooth reduction and potential pulp-dentine complex injury. It is well known that endodontic therapy is on the rise due to these aggressive preparations.
The early 80s and 90s saw the emergence of light cured composite use (PMMA filled with silica or zirconium) in places heretofore unacceptable in the profession. Minimally invasive dentistry became a byword at that time for many who would avoid tooth preparations deep into dentine as much as possible.
However, the new frontier today is Biomimetic dentistry. Biomimetics is known as “the study of the structure and function of biological systems as models for the design and engineering of materials and machines.” For example, composite is composed of: 1) a carbon chain polymer (PMMA) moiety structured much like polymer carbon chains of collagen or the protein rod substance holding enamel rods together (inter rod substance, amelogenin); and, 2) the silica moiety within composite could loosely be analogized to the mineral enamel rods held within the rod substance sheath. Ergo, we have silica within PMMA (composite) as developed by humans. And, enamel rods within amelogenin (human enamel) as developed by Nature.
Dr. Gordon Christianson, well known to Dentistry Today readers, reported his concern regarding pulpal death due to over reduction of teeth in his Clinical Research Associates Newsletter of 1995.(1) At that time he mentioned computer data that demonstrated a close and “significant” correlation of deep crown preparations and resultant need for endodontic therapy. Much research has been done since then on the ill affects and effects of high speed cutting on enamel and dentine. This can be observed in our daily experiences as dental practitioners, if one looks with diligence.
A second alert regarding “killing teeth” surfaced in 2005 in an article “How to Kill A Tooth” that again advused the profession to the dangers of radical misguided tooth reduction.(2) Other authors have also voiced their cautionary papers on the subject as did those of the early 20th Century.(6)
The systematic and simple replacement of missing teeth without radical manipulation of existing sound structure (tooth mutilation), utilizing scaffolding, or a matrix, of prefabricated material may correctly be characterized as bio-synthetic tissue engineering—SYNERGY. A whole new conversation about the direction of dentistry for the 21st Century is offered in Stephan C. Bayne’s review of the state of the art for restorative biomaterials titled Dental Biomaterials: Where Are We and Where Are We Going.
We present this principle, synergy, as observed in the profession of dentistry, demonstrated in Table 1.
Removable flipper Traditional bridge Dental Implant Carlson Bridge®
Cost | ~$1,740.00 | ~$4,500.00 | ~$6,400.00 | ~$2,100.00 |
1. No. of Visits | 2-3 | 3-5 | 12-20 | 1 |
2. Definitive | No | Yes | Yes | Yes |
3. Lifespan | 6 mo.—1yr. | 3—5yrs. | ? | 3—5yrs. |
4. Tissue Altered | Little | Yes | Yes | None |
5. Completion time | 1—2 Weeks | About 1 month | 6mo.—1 year | 1.5 hours |
6. Time in chair | 1 hour | 3—6 hours | 5— 15 hours | ~1.5 hour |
7. Expected pain | No | Moderate to High | Moderate to High | No |
8. Needed meds | No | Yes | Yes | No |
9. Easily modified | No | No | No | Yes |
10.Alter Shade | No | No | No | Yes-Anytime |
11.LaboratoryCost | Yes | Yes—High | Yes—Very High | None |
12. Stress Doctor | Very little | Very High | Very High | Little/ Moderate |
13. Galvanic I (uA) | (Clasps) -2-3uA | (Metal) -3-12uA | (Tit.)-30–200uA1 | None |
14. Stress Patient | Little | Moderate/High | Very High | Minimum-None |
15. Death Threat | None | Moderate | Moderate /High | None |
Table 1. Single Tooth Synergetic Replacement Comparison
What Carlson Bridge® Technologies has shown since 1999 is that a fixed dental bridge of very high standards and quality can be done in as little as an hour with restorative dental composites of superior structure, without internal fiber support as proposed by many companies, and a totally new conceptioning.
The art of bridging utilizing minimal tooth reduction had seen very little advancement until denture teeth were first used with fibers and composites.(3) Various clinicians around the early 1990’s began to use glass fibers, Kevlar fibers, or other polyethylene fibers as a means of adhering the denture tooth to the natural abutments. Now, most major dental suppliers of dental composites offer their brand of fiber to reinforce tooth attachment in their system false tooth placement.
The use of macro-fiber reinforcement such as this is optional, since its capacity to strengthen the bridge is contentious at best.(3,4,5,6,7,8,9,10) Another common objection to fiber reinforcement methodology is that it is technique sensitive. One must meticulously pay attention to imbedding all fiber portions within the over lying composite and not leaving fiber exposed. We find this method unnecessary, bulky, very time consuming and potentially weakens the bridge rather than strengthening it. Our testing, in concert with with Knight and Whittaker’s, reported a 10 to 15% weakening effect; while van Heumen and Jokstad said the strengthening is equivocal.(10,11) At best no body really knows.
Pure acrylic denture teeth made of PMMA (Poly Methyl Methacrylate) will not bond or polymerize with composites. Their success was dependent on mechanical factors alone and not any chemical bonding factors. The surface interface of the PMMA denture tooth and the composite material used to bond the pontic to the support teeth was the weakest link. Actually there was no link at all since there was nothing to bond to, that is, without silica within the PMMA, there is no covalent bond. We now have PMMA denture teeth that have been said to incorporate nano-hybrid composite, but if that is true, we find that these denture teeth still will not bond to conventional composites either.
There is a very small population of dentists, which is growing in numbers, who are avoiding traditional radical tooth reduction for fixed bridges or who would like to offer an alternative method of tooth replacement for their patients. The art of bridging, or other restorative procedures, for this fraction of bio-dentists is moving in this direction. The recent appearance last year of the Componeer prefabricated laminate system by Coltene-Whaledent witnesses this phenomenon. Other companies are following this innovation of prefab laminates used in the dental office.
WHAT IS THE “WINGED PONTIC” PREFAB BRIDGE?
Our system of composite tooth replacement began September 1989 and avoided the cumbersome and ineffectual use of fibers. Although macro-fiber reinforcement appears as if it would strengthen attachments and composite itself, much like metal rods in concrete, results vary and are equivocal. Again, our studies noted previously found that macro-fibers weakened the composite matrix, rather than strengthened it by about 10-15% as they did in the studies of Knight and Whittaker.
Previous to this innovation, the art of bridging was a slow and methodical lamination of the pontic and then sculpting it as desired. The new Preformed Design Bridging presented as the prefabricated “Winged Pontic” tooth replacement system, employees preformed composite tooth forms that are first adjusted to fit the space of the missing tooth or teeth. Once adjusted to the space, the composite is added to the natural attachment teeth, the appropriate surfaces of the pontic, and gingerly set into the space at the doctor’s discretion and preference. The excess material is smoothed onto the abutment teeth and the pontic and then bonded in place. Successive layers of finishing composite are added for strength and aesthetics. Following this phase, the sculpting is employed to craft a custom prefab composite bridge of superior quality.
This patient, a 47 years old female, was not able to afford a more comprehensive treatment plan. Her budget was limited. She chooses the “Winged Pontic” option rather than the “flipper.”
In photo 1 a missing lateral incisor, tooth #7 is seen. The prefabricated “Winged Pontic” is seen in photo 2.
Photo 3 shows the prefab “Winged Pontic” trimmed and adjusted into the space between the support teeth without attachment composite affixed. The line of placement is confirmed as the “Winged Pontic” is adjusted.
Photo 4 shows the “Winged Pontic” lateral incisor #7 with attachment composite applied to the proximal surfaces ready for insertion between #6 and #8, but only after preparation.
After treating the enamel of support teeth #6 and #8 with etchant, water cleaning and drying, clear resin and attachment composite are applied to proximal surfaces seen in Photo 5.
The prefab “Winged Pontic” (Photo 4) has first been etched for 30 seconds, cleaned with water, next treated with the CB® “WP” Bond Enhancer, clear resin is applied, followed by attachment composite application to proximal surfaces as seen in Photo 4. The pontic is now ready for insertion between the support teeth.
The prefabricated, pretreated “Winged Pontic” is carried to the space and inserted as seen Photos 6 and 7 in the predetermined line of draw. The attachment composite is smoothed over all aspects of the pontic and support teeth and then light cured.
The “Winged Pontic” is layered over with the practitioner’s choice of finishing composite. This is a time when creative artistic skills may be applied. Once cured, the occlusion is checked and adjusted in all excursions. Various flame shaped finishing diamonds are used for characterization. Final polish may be done with fine finishing diamonds 25 micron and 50 micron, and rubber wheels.
Final results are demonstrated in Photos 8 and 9.
A New Persepctive
This process, the Carlson Bridge® “Winged Pontic” tooth replacement system may open doors to new possibilities in the way dentists practice. Bio-synthetic tissue engineering (11) is the leading edge in dentistry today.
This modern system of tooth replacement may also be a pleasant experience for the patient who can shorten his or her time in the dental chair and come away with an immediate dental cosmetic enhancement. Additionally, it will not create a financial burden or, require extensive healing time or unnecessary oral discomfort. The average cost of a traditional three tooth fixed bridge in Honolulu, after having two teeth reduced to pencil pegs, is about $4,400.00. Our case study patient was charged $2, 100.00 and was more than happy with that. In this day and age of limited dental health budgets, it is an idea whose time has come.
It is also beneficial to the dental practitioner since the procedure is shorter in duration, therefore physically less demanding, less complicated in that intricate tooth preparations are unnecessary, and ultimately more rewarding creatively, artistically and remuneratively.
1) Missing lateral incisor #7 was due to a failed root canal. Both central incisior and cuspid were untouched and in good health.
2) Prefabricated incisor composite, "Winged Pontic," facial aspect before adjustment.
3) Adjusted "Winged Pontic" passively set into the edentulous space prior to the attachment phase, thus ensuring proper positioning and fit.
4) "Winged Pontic" with soft attachment composite on proximal surfaces, after the addition of CB-Silane and resin to the "Winged Pontic" body.
5) After etching and cleaning the support teeth surfaces, the soft attachment composite is applied for the attachment phase.
6) At the attachment phase, the "Winged Pontic" is gingerly inserted into the space according to its previously determined line of draw.
7) Soft composite is gently layered over the "Winged Pontic," both the facial and lingual aspects of support teeth, and photo cured.
8) Preliminary sculpting is accomplished with medium to fine flame diamonds and rubber wheels after the occlusion is adjusted.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
